Electronic Health Record: The big IT-lusion?

17. August 2012

Does electronic health administration bring significant savings to the strained public health system? No, says a U.S. study, which put the prescription and referral practices of general practitioners under the microscope.

According to the study doctors who rely significantly more on the digital analysis of examinations prescribe many more (additional) examinations than those colleagues who depend on traditional paper documents and analogue analyses. U.S. health experts, consultants, politicians and the Obama administration have repeatedly argued that the widespread access to electronic health records would lead to substantial cost savings in the U.S. health system. Thus, the American Recovery and Reinvestment Act (ARRA), the law aimed at the recovery of and investment in the U.S. economy, has made reference since 2009 to dramatically expanding and thus increasing public spending on subsidies to Health Information Technology for Economic and Clinical Health (HITECH).

The U.S. think tank RAND (Research and Development) Corporation, which was founded after the Second World War originally to advise the U.S. armed forces and in recent years has pointed out issues to society such as the growing obesity in the U.S. population and problems of drug abuse in U.S. high schools, recently calculated that about 80 billion U.S. dollars per year could be saved through the widespread use of digital examination analysis. And this especially in the area of imaging techniques (computer tomography, magnetic resonance imaging and positron emissions tomography (PET)) which already ten years ago in the U.S. were responsible for about 14 percent of total outpatient costs. With better evaluation, considerable cost savings can be made concludes the New York Times from the study results of the U.S. think tank which, on the grounds of cost savings, speaks out in favour of the increased use of electronic patient records.

Data from 28,000 patients under the microscope

The new Health Affairs Study, which is based on the calculations from the government’s National Center for Health Statistics (NCHS), has put the medical records of no less than 28,741 U.S. citizens and 1,187 general practitioners under the microscope. The main outcome of the study: those physicians who worked with electronic patient record systems prescribed for 18 percent of their patients further tests for clarification purposes, while those who worked on a paper basis only transferred 12.9 percent to further tests. The tendency toward more expensive additional tests was far higher among physicians who relied on digital data base – that is, somewhere between 40 and as much as 70 percent more for these “digitalised” physicians as compared to their “analogue” based colleagues.

Useful or not?

In addition, the electronic availability of laboratory test results was often associated with the arrangement of additional blood tests. The availability of electronic patient records was not in itself the reason for the arrangement of further tests; the electronic access to test results therefore appears to have been the trigger. A possible rationale for this is the suggestion that access to electronic data made more time available to the doctors and that they used this advantage so as to order additional imaging tests. This “convenience” effect of electronic data access could be responsible for the fact that potential reductions in additional study requests is balanced by unnecessary multiple tests. Another possible explanation says that doctors who employ imaging tests more often – for whatever reason – probably use digital health technologies, which increases their intuitive access to image-based evaluations.

“We doubt that the use of electronic health technologies – whatever their other benefits may be – represents a meaningful cost reduction strategy”, says study author Danny McCormick, Assistant Professor of Medicine at Harvard Medical School and Director of the Division of Social and Public Health of the Medical Department of the Cambridge Health Alliance and Co-Director of the Harvard Medical School Scholarship program of General Medicine and Primary Health Care. “Whatever the exact reasons for our study results are, they show how important it is to exactly determine the benefits of computer-aided data acquisition instead of, due to a lack of data, or on the basis of small studies made of non-representative institutions, making generalised statements”, McCormick warns.

Variable interpretation of the results

U.S. health experts like Obama-adviser David Blumenthal, who also does research at the Harvard Medical School, argue against the data results, that data from 2008 to which the study refers would have merited an analysis of the general examination behaviour of doctors. It was actually just last year that the use of electronic health data started to be investigated, says Blumenthal to the New York Times.

He also regarded the new study as an outlier in a large series of investigations. Study author McCormick holds, however, that studies such as those from RAND until now have only been based on statistical samples of rather easily managed groups. This time we have gotten hold of data from a really large institution, says McCormick. Critics of the electronic health system point out that we currently spend relatively high sums of funding on transition activities to electronic systems, the benefits of which – especially in economic terms – are however difficult to foresee.